DAST-28 severity and injection-related harm risks among people using psychoactive substances in psychiatric and correctional settings in Mongolia: a multicenter cross-sectional study

Abstract

Introduction Evidence on drug-related problem severity and injection-related harm among people using psychoactive substances in Mongolia is limited, particularly in institutional settings. We examined DAST-28 scores, internal consistency, and behavioral correlates in psychiatric and correctional settings. Methods This multicenter cross-sectional study included 181 participants recruited from the National Center for Mental Health and correctional facilities. The continuous DAST-28 total score was the primary outcome. Internal consistency was evaluated from 28 item responses. A clinically specified seven-covariate linear model with HC3 heteroskedasticity-robust standard errors was primary; ordinal and study-defined DAST-28 ≥ 12 models were supportive analyses. Results DAST-28 scores were available for 179 participants (median 11.0, interquartile range 6.0–16.0). Among 170 participants with complete item responses, Cronbach's alpha was 0.882 (95% bootstrap confidence interval 0.854–0.902). In the primary model, correctional setting was associated with a 1.82-point lower score (95% CI -3.36 to −0.28), whereas each additional year of use (B = 0.27, 95% CI 0.08–0.45), polysubstance use (B = 2.64, 95% CI 0.79–4.50), and any syringe use (B = 4.43, 95% CI 2.58–6.28) were associated with higher scores. Ordinal and threshold analyses were concordant; variance inflation factors ranged from 1.05 to 1.59. Conclusions Greater DAST-28 scores were associated with polysubstance use, syringe use, and longer use duration in these institutional samples. The findings may inform comprehensive assessment and harm-reduction linkage but do not establish a diagnostic cutoff, causal relationship, intervention effectiveness, or population prevalence.